Individual
DR. MICHAEL D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1104 PROFESSIONAL BLVD, DALTON, GA 30720-2588
(706) 226-5533
(706) 428-0033
Mailing address
1104 PROFESSIONAL BLVD, DALTON, GA 30720-2588
(706) 226-5533
(706) 529-5858
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
041498
GA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
041498
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00869525B
—
GA
01
—
927802
BCBS EDI
GA
Enumeration date
10/02/2006
Last updated
12/19/2008
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